2005 Texas Health & Safety Code CHAPTER 322. USE OF RESTRAINT AND SECLUSION IN CERTAIN HEALTH CARE FACILITIES

HEALTH & SAFETY CODE

CHAPTER 322. USE OF RESTRAINT AND SECLUSION IN CERTAIN HEALTH CARE 
FACILITIES

SUBCHAPTER A. GENERAL PROVISIONS




	§ 322.001. DEFINITIONS.  In this chapter:                                   
		(1)  "Facility" means:                                                        
			(A)  a child-care institution, as defined by 
Section 42.002, Human Resources Code, including a state-operated 
facility, that is a residential treatment center or a child-care 
institution serving children with mental retardation;
			(B)  an intermediate care facility licensed by the 
Department of Aging and Disability Services under Chapter 252 or 
operated by that department and exempt under Section 252.003 from 
the licensing requirements of that chapter;
			(C)  a mental hospital or mental health facility, 
as defined by Section 571.003;
			(D)  an institution, as defined by Section 
242.002;                        
			(E)  an assisted living facility, as defined by 
Section 247.002;  or       
			(F)  a treatment facility, as defined by Section 
464.001.                  
		(2)  "Health and human services agency" means an agency 
listed in Section 531.001, Government Code.
		(3)  "Seclusion" means the involuntary separation of a 
resident from other residents and the placement of the resident 
alone in an area from which the resident is prevented from leaving.

Added by Acts 2005, 79th Leg., ch. 698, § 1, eff. Sept. 1, 2005.           

SUBCHAPTER B. RESTRAINTS AND SECLUSION


	§ 322.051. CERTAIN RESTRAINTS PROHIBITED.  (a) A person 
may not administer to a resident of a facility a restraint that:
		(1)  obstructs the resident's airway, including a 
procedure that places anything in, on, or over the resident's mouth 
or nose;
		(2)  impairs the resident's breathing by putting 
pressure on the torso;  or 
		(3)  interferes with the resident's ability to 
communicate.                 
	(b)  A person may use a prone or supine hold on the resident 
of a facility only if the person:
		(1)  limits the hold to no longer than the period 
specified by rules adopted under Section 322.052;
		(2)  uses the hold only as a last resort when other less 
restrictive interventions have proven to be ineffective;  and
		(3)  uses the hold only when an observer, who is trained 
to identify the risks associated with positional, compression, or 
restraint asphyxiation and with prone and supine holds and who is 
not involved in the restraint, is ensuring the resident's breathing 
is not impaired.
	(c)  Small residential facilities and small residential 
service providers are exempt from Subsection (b)(3).

Added by Acts 2005, 79th Leg., ch. 698, § 1, eff. Sept. 1, 2005.           


	§ 322.052. ADOPTION OF RESTRAINT AND SECLUSION 
PROCEDURES.  (a) For each health and human services agency that 
regulates the care or treatment of a resident at a facility, the 
executive commissioner of the Health and Human Services Commission 
shall adopt rules to:
		(1)  define acceptable restraint holds that minimize 
the risk of harm to a facility resident in accordance with this 
subchapter;
		(2)  govern the use of seclusion of facility residents;  
and                
		(3)  develop practices to decrease the frequency of the 
use of restraint and seclusion.
	(b)  The rules must permit prone and supine holds only as 
transitional holds for use on a resident of a facility.
	(c)  A facility may adopt procedures for the facility's use 
of restraint and seclusion on a resident that regulate, more 
restrictively than is required by a rule of the regulating health 
and human services agency, the use of restraint and seclusion.

Added by Acts 2005, 79th Leg., ch. 698, § 1, eff. Sept. 1, 2005.           


	§ 322.053. NOTIFICATION.  The executive commissioner of 
the Health and Human Services Commission by rule shall ensure that 
each resident at a facility regulated by a health and human services 
agency and the resident's legally authorized representative are 
notified of the rules and policies related to restraints and 
seclusion.

Added by Acts 2005, 79th Leg., ch. 698, § 1, eff. Sept. 1, 2005.           


	§ 322.054. RETALIATION PROHIBITED.  (a) A facility may 
not discharge or otherwise retaliate against:
		(1)  an employee, client, resident, or other person 
because the employee, client, resident, or other person files a 
complaint, presents a grievance, or otherwise provides in good 
faith information relating to the misuse of restraint or seclusion 
at the facility;  or
		(2)  a client or resident of the facility because 
someone on behalf of the client or resident files a complaint, 
presents a grievance, or otherwise provides in good faith 
information relating to the misuse of restraint or seclusion at the 
facility.
	(b)  A health and human services agency that registers or 
otherwise licenses or certifies a facility may:
		(1)  revoke, suspend, or refuse to renew the license, 
registration, or certification of a facility that violates 
Subsection (a);  or
		(2)  place on probation a facility that violates 
Subsection (a).            
	(c)  A health and human services agency that regulates a 
facility and that is authorized to impose an administrative penalty 
against the facility under other law may impose an administrative 
penalty against the facility for violating Subsection (a).  Each 
day a violation continues or occurs is a separate violation for 
purposes of imposing a penalty.  The amount of the penalty may not 
exceed the maximum amount that the agency may impose against the 
facility under the other law.  The agency must follow the procedures 
it would follow in imposing an administrative penalty against the 
facility under the other law.
	(d)  A facility may contest and appeal the imposition of an 
administrative penalty under Subsection (c) by following the same 
procedures the facility would follow in contesting or appealing an 
administrative penalty imposed against the facility by the agency 
under the other law.

Added by Acts 2005, 79th Leg., ch. 698, § 1, eff. Sept. 1, 2005.           


	§ 322.055. MEDICAID WAIVER PROGRAM.  A Medicaid waiver 
program provider, when providing supervised living or residential 
support, shall comply with this chapter and rules adopted under 
this chapter.

Added by Acts 2005, 79th Leg., ch. 698, § 1, eff. Sept. 1, 2005.           




	§ 322.001. DEFINITIONS.  In this chapter:                                   
		(1)  "Community-wide plan" means an agreement entered 
into between one or more health care facilities, entities 
administering a sexual assault program, district attorney's 
offices, or law enforcement agencies that designates one or more 
health care facilities in the community as a primary health care 
facility to furnish emergency medical services and evidence 
collection to sexual assault survivors on a community or area-wide 
basis.
		(2)  "Department" means the Department of State Health 
Services.            
		(3)  "Health care facility" means a general or special 
hospital licensed under Chapter 241 or a general or special 
hospital owned by this state.
		(4)  "Sexual assault" means any act as described by 
Section 22.011 or 22.021, Penal Code.
		(5)  "Sexual assault survivor" means an individual who 
is a victim of a sexual assault, regardless of whether a report is 
made or a conviction is obtained in the incident.

Added by Acts 2005, 79th Leg., ch. 934, § 1, eff. Sept. 1, 2005.           


	§ 322.002. PLAN FOR EMERGENCY SERVICES.  (a) At the 
request of the department, a health care facility shall submit to 
the department for approval a plan for providing the services 
required by Section 322.004 to sexual assault survivors who arrive 
for treatment at the emergency department of the health care 
facility.
	(b)  The department shall adopt procedures for submission, 
approval, and modification of a plan required under this section.
	(c)  A health care facility shall submit the plan required by 
this section not later than the 60th day after the date the 
department requests the plan.
	(d)  The department shall approve or reject the plan not 
later than the 120th day after the date the plan is submitted.

Added by Acts 2005, 79th Leg., ch. 934, § 1, eff. Sept. 1, 2005.           


	§ 322.003. REJECTION OF PLAN.  (a) If a plan required 
under Section 322.002 is not approved, the department shall:
		(1)  return the plan to the health care facility;  and                        
		(2)  identify the specific provisions under Section 
322.004 with which the plan conflicts or does not comply.
	(b)  Not later than the 90th day after the date the 
department returns a plan to a health care facility under 
Subsection (a), the facility shall correct and resubmit the plan to 
the department for approval.

Added by Acts 2005, 79th Leg., ch. 934, § 1, eff. Sept. 1, 2005.           


	§ 322.004. MINIMUM STANDARDS FOR EMERGENCY SERVICES.  (a) 
After a sexual assault survivor arrives at a health care facility 
following an alleged sexual assault, the facility shall:
		(1)  provide care to the survivor in accordance with 
Subsection (b);  or    
		(2)  stabilize and transfer the survivor to a health 
care facility designated in a community-wide plan as the primary 
health care facility in the community for treating sexual assault 
survivors, which shall provide care to the survivor in accordance 
with Subsection (b).
	(b)  A health care facility providing care to a sexual 
assault survivor shall provide the survivor with:
		(1)  a forensic medical examination in accordance with 
Subchapter B, Chapter 420, Government Code, if the examination has 
been approved by a law enforcement agency;
		(2)  a private area, if available, to wait or speak with 
the appropriate medical, legal, or sexual assault crisis center 
staff or volunteer until a physician, nurse, or physician assistant 
is able to treat the survivor;
		(3)  access to a sexual assault program advocate, if 
available, as provided by Article 56.045, Code of Criminal 
Procedure;
		(4)  the information form required by Section 322.005;                        
		(5)  a private treatment room, if available;                                  
		(6)  if indicated by the history of contact, access to 
appropriate prophylaxis for exposure to sexually transmitted 
infections;  and
		(7)  the name and telephone number of the nearest 
sexual assault crisis center.
	(c)  A health care facility must obtain documented consent 
before providing the forensic medical examination and treatment.

Added by Acts 2005, 79th Leg., ch. 934, § 1, eff. Sept. 1, 2005.           


	§ 322.005. INFORMATION FORM.  (a) The department shall 
develop a standard information form for sexual assault survivors 
that must include:
		(1)  a detailed explanation of the forensic medical 
examination required to be provided by law, including a statement 
that photographs may be taken of the genitalia;
		(2)  information regarding treatment of sexually 
transmitted infections and pregnancy, including:
			(A)  generally accepted medical procedures;                                  
			(B)  appropriate medications;  and                                           
			(C)  any contraindications of the medications 
prescribed for treating sexually transmitted infections and 
preventing pregnancy;
		(3)  information regarding drug-facilitated sexual 
assault, including the necessity for an immediate urine test for 
sexual assault survivors who may have been involuntarily drugged;
		(4)  information regarding crime victims compensation, 
including:           
			(A)  a statement that a law enforcement agency 
will pay for the forensic portion of the examination;  and
			(B)  reimbursement information for the medical 
portion of the examination; 
		(5)  an explanation that consent for the forensic 
medical examination may be withdrawn at any time during the 
examination;
		(6)  the name and telephone number of sexual assault 
crisis centers statewide;  and
		(7)  information regarding postexposure prophylaxis 
for HIV infection.      
	(b)  A health care facility shall use the standard form 
developed under this section.
	(c)  An individual employed by or under contract with a 
health care facility may refuse to provide the information form 
required by this section for ethical or religious reasons.  If an 
individual employed by or under contract with a health care 
facility refuses to provide the survivor with the information form, 
the health care facility must ensure that the information form is 
provided without delay to the survivor by another individual 
employed by or under contract with the facility.

Added by Acts 2005, 79th Leg., ch. 934, § 1, eff. Sept. 1, 2005.           


	§ 322.006. INSPECTION.  The department may conduct an 
inspection of a health care facility to ensure compliance with this 
chapter.

Added by Acts 2005, 79th Leg., ch. 934, § 1, eff. Sept. 1, 2005.